Affirming the view of many consumers of mental health services, the Surgeon General's Report on Mental Health places overcoming stigma at the forefront of the nation's efforts to promote mental health. Although we know a great deal about how stigma adversely impacts psychological well-being and denies people access to opportunities, we need to know more about how mental illness labels initially come to have meaning and consequences for individuals who are exposed to them. We need to capture this information as it unfolds over time in the careers of people who develop serious mental illnesses. As a step towards reaching this ultimate goal of understanding and intervention, this developmental proposal seeks funds to develop and evaluate new measures in order to achieve a multi-method assessment of stigma. Specifically we will: a) develop ratings of stigma components using narratives derived from semi-structured interviews with patients concerning events in the period before, during and after their first hospitalization, b) develop ratings that assess shame, embarrassment, humiliation, anger and other stigma-related feelings by coding audiotapes and transcripts of open-ended reports about processes and events and, c) conduct direct observations and key- informant interviews to assess stigma-relevant contextual factors and to construct a narrative parallel to the patients narrative but derived from hospital records and interviews with mental health staff and relatives. This R21 will yield interview and observation protocols, coding manuals, and evidence concerning the reliability and validity of a multi-method approach to assessing stigma. This information will be useful to other researchers studying stigma and will form the basis of a larger prospective study that will assess the impact of stigma on important outcomes and inform interventions to reduce the influence of stigma in the lives of people with mental illness. [unreadable] [unreadable] [unreadable]